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Rogers AH, Palermo TM, Groenewald CB, Murray CB. Adolescent predictors of substance use in young adulthood among individuals with childhood-onset chronic pain: A follow-up study. Eur J Pain 2024. [PMID: 39248201 DOI: 10.1002/ejp.4724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Adolescent chronic pain is a substantial public health problem, and pain symptoms often persist into adulthood. Young adults with chronic pain are at elevated risk for more frequent tobacco, alcohol and cannabis use, and cross-sectional research highlights the importance of psychosocial vulnerability factors. Limited research has examined how adolescent predictors, including mental health symptoms, pain, sleep and family functioning, impact later, young adult substance use. METHODS A prospective cohort of 229 young adults (77.3% female; Mage = 21.0, SD = 1.6) with childhood-onset chronic pain completed measurements in adolescence and a follow-up assessment in young adulthood of past 3-month substance use frequency. RESULTS Adolescent sleep quality and male sex were associated with more frequent tobacco use; adolescent depression was associated with more frequent alcohol use, and adolescent pain severity was associated with less frequent, and male sex was associated with more frequent cannabis use. CONCLUSIONS Adolescent predictors of young adult substance use among youth with childhood-onset chronic pain represent important factors that may inform assessment, prevention and treatment of substance use in this population. Identifying and testing psychological interventions that target these vulnerability factors may reduce overall substance use risk in young adulthood. SIGNIFICANCE This prospective observational study of young adults with childhood-onset chronic pain identified adolescent depression and sleep quality as vulnerability factors associated with substance use. Given the increasing risk for substance use during adolescence and young adulthood, these findings highlight the potential importance of early intervention to reduce substance use among young adults with childhood-onset chronic pain.
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Affiliation(s)
- Andrew H Rogers
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Cornelius B Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caitlin B Murray
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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2
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Greenough MJ, Jibb L, Lewis KB, Bucknall T, Lamontagne C, Demery Varin M, Sokalski A, Squires JE. A systematic review of the biopsychosocial dimensions affected by chronic pain in children and adolescents: identifying reliable and valid pediatric multidimensional chronic pain assessment tools. Pain Rep 2023; 8:e1099. [PMID: 38033716 PMCID: PMC10686605 DOI: 10.1097/pr9.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 12/02/2023] Open
Abstract
Pediatric chronic pain is a complex experience that is often challenging to describe and measure. Multidimensional tools that evaluate the biopsychosocial impact of chronic pain in pediatric patients can help clinicians to prioritize and tailor interdisciplinary pain care; yet, the psychometric value and clinical utility of such tools has not yet been systematically studied in the literature. The purpose of this review was to identify multidimensional biopsychosocial tools used in pediatric chronic pain, synthesize their reliability and validity evidence, and draw on this evidence to describe the relationships between chronic pain and biopsychosocial domains. The search involved 2 phases to (1) identify eligible tools and (2) conduct a measured forward citation search of tool development articles. Tool eligibility was guided by the Multidimensional Biobehavioral Model of Pediatric Pain and study eligibility was focused on primary chronic pain diagnoses unrelated to disease. Data extraction was focused on reliability and validity evidence of eligible tools, guided by the Standards for Educational and Psychological Testing. Results yielded 6 tools that included 64 eligible studies, highlighting 84 significant relationships between pain and functional interference across 11 biopsychosocial variables. All tools were shown to have good internal consistency and evidence of validity, primarily through relationships to other variables. Of the 6 tools, the most brief and easy to use were the most under studied. Further psychometric research is warranted for these tools to investigate their clinical utility and psychometric properties in guiding and prioritizing pain care for children and adolescents.
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Affiliation(s)
- Megan J. Greenough
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lindsay Jibb
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Pediatric Nursing Research, SickKids Hospital, Toronto, ON, Canada
| | | | - Tracey Bucknall
- School of Nursing, Deakin University, Burwood Victoria, Melbourne, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Geelong, Australia
| | - Christine Lamontagne
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Ashley Sokalski
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Janet Elaine Squires
- University Research Chair in Health Evidence Implementation & School of Nursing, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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3
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Parsons RD, McParland JL, Halligan SL, Goubert L, Jordan A. Glass half full: A diary and interview qualitative investigation of flourishing among adolescents living with chronic pain. Eur J Pain 2023. [PMID: 37128852 DOI: 10.1002/ejp.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Counter to paediatric pain literature that typically highlights the deleterious impacts associated with adolescent chronic pain, evidence suggests that some adolescents flourish in their experience of pain. This study sought to explore how adolescents experience, understand and perceive flourishing while living with chronic pain. METHODS Twenty-four adolescents aged 11-24 years were recruited via clinical and online settings. All adolescents were asked to complete daily diary entries, with a subset of 10 participants asked to complete follow-up interviews. RESULTS Inductive reflexive thematic analysis generated two themes: 'Appreciating the moment' and 'Becoming a better version of myself'. Themes addressed how self and other comparisons facilitated a renewed appreciation for achievements and pleasures in life due to living with chronic pain. Adolescents further demonstrated a perception of continued personal and social growth in their experience of chronic pain, including increased emotional maturity, resilience, positivity, kindness and improved communication skills. CONCLUSIONS We conclude that adolescents can experience positive changes in functioning and flourish in some domains of life despite, or resulting from, chronic pain. Further research with an exclusive focus on flourishing is needed to build on this work and address this important gap in knowledge. SIGNIFICANCE We present evidence that adolescents can flourish when living with chronic pain. Such knowledge may inform the development of positive psychological treatment strategies that are focused on reinforcing adolescents' existing strengths, to expand on current treatment options for adolescents living with chronic pain.
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Affiliation(s)
- Ryan D Parsons
- Department of Psychology, University of Bath, Bath, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | | | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Centre for Pain Research, University of Bath, Bath, UK
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Smith NL, Smith MG, Gibson N, Imms C, Thornton AL, Harvey AR. Pain coping tools for children and young adults with a neurodevelopmental disability: A systematic review of measurement properties. Dev Med Child Neurol 2023; 65:318-328. [PMID: 36111806 PMCID: PMC10952855 DOI: 10.1111/dmcn.15410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/22/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
AIM To systematically identify and evaluate the measurement properties of patient-reported outcome measures (PROMs) and observer-reported outcome measures (parent proxy report) of pain coping tools that have been used with children and young adults (aged 0-24 years) with a neurodevelopmental disability. METHOD A two-stage search using MEDLINE, Embase, CINAHL, Web of Science, and PsycInfo was conducted. Search 1 in August 2021 identified pain coping tools used in neurodevelopmental disability and search 2 in September 2021 located additional studies evaluating the measurement properties of these tools. Methodological quality was assessed using the COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines (PROSPERO protocol registration no. CRD42021273031). RESULTS Sixteen studies identified seven pain coping tools, all PROMs and observer-reported outcome measures (parent proxy report) versions. The measurement properties of the seven tools were appraised in 44 studies. No tool had high-quality evidence for any measurement property or evidence for all nine measurement properties as outlined by COSMIN. Only one tool had content validity for individuals with neurodevelopmental disability: the Cerebral Palsy Quality of Life tool. INTERPRETATION Pain coping assessment tools with self-report and parent proxy versions are available; however, measurement invariance has not been tested in young adults with a neurodevelopmental disability. This is an area for future research.
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Affiliation(s)
- Nadine L. Smith
- Kids Rehab WAPerth Children's HospitalNedlandsWAAustralia
- Department of PhysiotherapyPerth Children's HospitalNedlandsWAAustralia
- Division of Paediatrics, Medical SchoolThe University of Western AustraliaWAAustralia
| | - Meredith G. Smith
- School of Allied Health Science and PracticeThe University of AdelaideSAAustralia
- Novita Disability ServicesAdelaideSAAustralia
| | - Noula Gibson
- Kids Rehab WAPerth Children's HospitalNedlandsWAAustralia
- Department of PhysiotherapyPerth Children's HospitalNedlandsWAAustralia
- Telethon Kids InstitutePerthWAAustralia
| | - Christine Imms
- Department of PaediatricsThe University of MelbourneVICAustralia
- Murdoch Children's Research InstituteMelbourneVICAustralia
| | - Ashleigh l. Thornton
- Kids Rehab WAPerth Children's HospitalNedlandsWAAustralia
- Division of Paediatrics, Medical SchoolThe University of Western AustraliaWAAustralia
- Telethon Kids InstitutePerthWAAustralia
| | - Adrienne R. Harvey
- Department of PaediatricsThe University of MelbourneVICAustralia
- Murdoch Children's Research InstituteMelbourneVICAustralia
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Household Food Insufficiency and Chronic Pain among Children in the US: A National Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020185. [PMID: 36832314 PMCID: PMC9954897 DOI: 10.3390/children10020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
This study aimed to determine the prevalence of pediatric chronic pain by household food sufficiency status and examine whether food insufficiency would be associated with greater risk for chronic pain. We analyzed data from the 2019-2020 National Survey of Children's Health of 48,410 children (6-17 years) in the United States. Across the sample, 26.1% (95% CI: 25.2-27.0) experienced mild food insufficiency and 5.1% (95% CI: 4.6-5.7) moderate/severe food insufficiency. The prevalence of chronic pain was higher among children with mild (13.7%) and moderate/severe food insufficiency (20.6%) relative to children in food-sufficient households (6.7%, p < 0.001). After adjusting for a priori covariates (individual: age, sex, race/ethnicity, anxiety, depression, other health conditions, adverse childhood events; household: poverty, parent education, physical and mental health; community: region of residence), multivariable logistic regression revealed that children with mild food insufficiency had 1.6 times greater odds of having chronic pain (95% CI: 1.4-1.9, p < 0.0001) and those with moderate/severe food insufficiency, 1.9 higher odds (95% CI: 1.4-2.7, p < 0.0001) relative to food-sufficient children. The dose-response relationship between food insufficiency and childhood chronic pain highlights the importance of further research to identify underlying mechanisms and evaluate the impact of food insufficiency on the onset and persistence of chronic pain across the lifespan.
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6
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Brosbe MS, Thompson CC, Flanders XC, Day A, Ward C, Slifer KJ. Pain Catastrophizing and Functional Disability in Youth with Chronic Pain: An Examination of Indirect Effects. J Clin Psychol Med Settings 2022; 29:546-556. [PMID: 35545726 DOI: 10.1007/s10880-022-09877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
Pediatric pain conditions are not uncommon and may lead to functional disability. The purpose of this study is to examine indirect effects of pain catastrophizing on functional disability through anxiety, depression, and pain in youth with chronic pain. Participants included 197 youth (144 females, Mage = 14.67 years) with chronic pain conditions. Youth completed self-report measures of pain catastrophizing, depression, anxiety, pain intensity, and functional disability. Caregivers also completed a measure of youth functional disability. Using a cross-sectional design, a multiple mediator model was estimated with pain catastrophizing as the predictor, functional disability as the outcome, and depression, anxiety, and pain intensity as mediators. Results supported a mediation model in which depression (B = 0.1145, SE = 0.0528, Z = 2.1686; B = 0.1512, SE = 0.0585, Z = 2.5846) and pain intensity (B = 0.1015, SE = 0.0422, Z = 2.4052; B = 0.0634, SE = 0.0343, Z = 1.8484) significantly mediated the effects of catastrophizing on child self-report and parent-report functional disability, respectively, while anxiety (B = - 0.0260, SE = 0.0439501, Z = - 0.5923; B = - 0.0637, SE = 0.0552, Z = - 1.1540) did not. Theoretical and clinical applications are discussed.
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Affiliation(s)
- Micah S Brosbe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg 12, Baltimore, MD, 21287, USA.
| | - Caitlin C Thompson
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ximena C Flanders
- South Florida Pediatric Psychology, Parkland, FL, USA
- JDCH Pediatric Psychology, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Alyssa Day
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Cynthia Ward
- North Atlanta Pediatric Psychology, Roswell, GA, USA
| | - Keith J Slifer
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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7
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Physical multimorbidity predicts the onset and persistence of anxiety: A prospective analysis of the Irish Longitudinal Study on Ageing. J Affect Disord 2022; 309:71-76. [PMID: 35452758 DOI: 10.1016/j.jad.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aims of the present study were to examine prospective associations of multimorbidity (i.e., ≥2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship. METHODS Data from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. Anxiety referred to score ≥ 8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up. RESULTS Data on 5871 adults aged ≥50 years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, ≥3 chronic conditions were associated with a significant 1.89 (95% CI = 1.16-3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and ≥3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%-37.8% of the associations. CONCLUSION Multimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.
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8
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Tsai Owens MS, Biggs BK, Fahrenkamp AC, Geske J, Hofschulte DR, Harbeck-Weber C, Fischer PR. Physical Symptoms, Distress, and Functional Disability in Youth With Chronic Orthostatic Intolerance. J Pediatr Psychol 2022; 47:1185-1194. [PMID: 35699566 PMCID: PMC9960074 DOI: 10.1093/jpepsy/jsac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Youth with chronic orthostatic intolerance (OI) can experience significant physical, social, and academic functional debilitation. Previous studies have indicated associations among symptom severity, psychosocial factors, and functional disability. However, empirically tested models explaining how different medical and psychosocial factors may contribute to functional disability are lacking. The current cross-sectional study aimed to evaluate mediation, moderation, and additive models of the effect of physical symptoms and psychological distress on functional disability. METHODS One hundred and sixty-five youth (13-22 years old) undergoing medical evaluation of chronic OI symptoms completed measures of autonomic dysfunction symptom severity, depressive and anxiety symptoms, and functional disability. Models were evaluated using tests of indirect effects and linear and logistic regression analyses. RESULTS Results supported the mediation and additive effects models for depressive symptoms. Mediation, moderation, and additive models for hypothesized effects of anxiety symptoms were not supported. CONCLUSIONS Results provide preliminary support for models in which OI symptoms affect functional debility via their effects on mood and in which depressive symptoms have unique and additive effects on functioning. Findings lay the foundation for longitudinal and experimental evaluation of biopsychosocial models of functional disability in youth with chronic OI and related conditions. Implications include the importance of a biopsychosocial conceptualization of OI symptoms and debility as a complex interplay of factors rather than as a purely physiological or psychological process.
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Affiliation(s)
| | - Bridget K Biggs
- All correspondence concerning this article should be addressed to Bridget Biggs, PhD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail:
| | - Amy C Fahrenkamp
- Pain, Palliative Care, and Integrative Medicine Department, Children’s Hospitals and Clinics of Minnesota, USA
| | - Jennifer Geske
- Department of Quantitative Health Sciences, Mayo Clinic, USA
| | | | | | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, USA,Department of Pediatrics, Sheikh Shakhbout Medical City, United Arab Emirates,Khalifa University, United Arab Emirates
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9
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Gibler RC, Abelson E, Williams SE, Lynch-Jordan AM, Kashikar-Zuck S, Jastrowski Mano KE. Establishing the Content Validity of a Modified Bank of School Anxiety Inventory Items for Use Among Adolescents With Chronic Pain. J Pediatr Psychol 2022; 47:1044-1056. [PMID: 35582894 PMCID: PMC9801705 DOI: 10.1093/jpepsy/jsac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE School anxiety is a prevalent mental health concern that drives school-related disability among youth with chronic pain. The only available measure of school anxiety-the School Anxiety Inventory, Short Version (SAI-SV)-lacks content specificity for measuring school anxiety in pediatric pain populations. We aimed to refine the SAI-SV by obtaining qualitative data about unique school situations that are anxiety-provoking for youth with pain and characterizing the nature of symptoms experienced in these situations. METHODS Adolescents with chronic pain (n = 16) completed a semistructured interview focused on experiences with anxiety in school-related academic and social contexts. We employed thematic analysis to extend the empirical understanding of school anxiety from the perspective of patients suffering from pain and to generate new item content. The content was refined with iterative feedback from a separate group of adolescents with chronic pain (n = 5) and a team of expert pain psychologists (n = 3). RESULTS We identified six themes within the data and generated new items designed to capture anxiety related to negative interactions with teachers and peers, falling behind with schoolwork, and struggles with concentration and fatigue. Participants and experts rated new item content as highly relevant for use among youth with pain. The updated item bank was named the School Anxiety Inventory for Chronic Pain. CONCLUSIONS Future research is needed to complete the psychometric evaluation of the item bank and finalize items to be included in a measure that can be used in research and clinical settings. Implications for treating school-related anxiety among youth with pain are also discussed.
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Affiliation(s)
- Robert C Gibler
- All correspondence concerning this article should be addressed to Robert C. Gibler, PhD, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 7039, Cincinnati, OH 45229, USA. E-mail:
| | - Elana Abelson
- Department of Psychology, University of Cincinnati, USA
| | - Sara E Williams
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Anne M Lynch-Jordan
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, USA,Department of Pediatrics, University of Cincinnati College of Medicine, USA
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10
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Kalomiris AE, Ely SL, Love SC, Mara CA, Cunningham NR. Child-Focused Cognitive Behavioral Therapy for Pediatric Abdominal Pain Disorders Reduces Caregiver Anxiety in Randomized Clinical Trial. THE JOURNAL OF PAIN 2022; 23:810-821. [PMID: 34902549 PMCID: PMC9086118 DOI: 10.1016/j.jpain.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
Pediatric functional abdominal pain disorders (FAPD) are associated with elevated anxiety in youth and their caregivers, both contributing to an adverse impact on functioning in youth with FAPD. While a CBT approach (ie, Aim to Decrease Anxiety and Pain Treatment [ADAPT]) is known to improve health outcomes for youth, it is unknown if child-focused treatment improves caregiver anxiety. This secondary analysis of a larger randomized clinical trial examined if child-focused CBT (ADAPT) for pain and anxiety also impacts caregiver anxiety and explored the relation between caregiver anxiety and child symptoms (ie, pain, disability, anxiety) after treatment. A total of 79 caregiver-child dyads were randomized to ADAPT plus treatment as usual (TAU) or TAU only. Caregiver anxiety and child outcomes (pain, disability, anxiety) were assessed at baseline and approximately 8 weeks later. Caregivers of children who completed ADAPT+TAU demonstrated lower anxiety compared to those who only received TAU. Moreover, regardless of treatment assignment, caregivers with greater anxiety had children who reported more pain and anxiety, but not functional disability at post-assessment. Results suggest a brief, child-focused intervention targeting pain and anxiety may also improve caregiver anxiety. As such, suggestions to improve future treatments are offered. PERSPECTIVE: Caregiver anxiety symptoms diminished after their child with functional abdominal pain completed a course of child-focused CBT targeting pain and anxiety. Further, caregiver anxiety was related to child-reported symptoms (pain and anxiety) after treatment. Therefore, improved caregiver mental health via a child-focused CBT may also improve pediatric outcomes.
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Affiliation(s)
- Anne E Kalomiris
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Samantha L Ely
- Department of Family Medicine, Michigan State University, Grand Rapids, Michigan
| | - Sarah C Love
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
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11
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Wainwright E, Jordan A, Fisher E, Wilson C, Mullen D, Madhavakkannan H. Beliefs About Worry and Pain Amongst Adolescents With and Without Chronic Pain. J Pediatr Psychol 2021; 47:432-445. [PMID: 34725707 DOI: 10.1093/jpepsy/jsab109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore beliefs about worries, beliefs about pain, and worries about pain held by adolescents with and without chronic pain. METHODS Adolescents with and without chronic pain aged 14-19 completed an online survey with free text questions about pain and worry. We collected demographics and used the Penn State Worry Questionnaire and Pain Catastrophizing Scale for Children to contextualize the qualitative data, which was analyzed with reflexive thematic analysis. RESULTS Eighty-one participants completed the survey, 36 with chronic pain and 45 without (mean age: 16.73). Compared to adolescents without chronic pain, adolescents living with chronic pain reported significantly higher general worry and pain catastrophizing. Thematic analysis generated two themes, "Worry changes perceptions of selfhood" and "Pain changes perceptions of selfhood." Each theme comprised two sub-themes showing how current and future identity trajectories were distorted by worry and pain. The theme "Pain changes perceptions of selfhood" also included a third sub-theme: "Pain impedes future working choices." Worry content as well as process was problematic in all adolescents. Adolescents experiencing chronic pain had specific, additional worries that pain reduces future career progression. These worries appeared highly salient and challenging. CONCLUSIONS Adolescents may need greater support in recognizing worry as part of normative development. Adolescents in pain may benefit from specific support identifying and reducing how pain-related worries interact with their futures and careers, and from school-based and vocational interventions to reduce the realistic risks they face negotiating modern labor markets.
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Affiliation(s)
- Elaine Wainwright
- Psychology Department, Bath Spa University, Bath, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.,Versus Arthritis MRC Centre for Musculoskeletal Health and Work, UK.,Centre for Pain Research, University of Bath, Bath, UK
| | - Abbie Jordan
- Centre for Pain Research, University of Bath, Bath, UK.,Department of Psychology, University of Bath, Bath, UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK.,Cochrane Pain, Palliative, and Supportive Care, Oxford University Hospitals, Oxford, UK
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12
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Brown DT, Claus BB, Könning A, Wager J. Unified Multifactorial Model of Parental Factors in Community-Based Pediatric Chronic Pain. J Pediatr Psychol 2021; 47:121-131. [PMID: 34414435 DOI: 10.1093/jpepsy/jsab085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The combination of parental chronic pain and internalizing characteristics are relevant to chronic pain experiences in their children. A promising unified multifactorial intergenerational model of chronic pain was published in 2019; however, this model was only generalizable to children with severe chronic pain and some factors had limitations. This study aimed to determine validity of an adapted multifactorial model, including parent and child chronic pain status, pain characteristics, pain-related functioning, and internalizing symptoms, in a community setting. Subgroup analyses based on presence of chronic pain in parents and children were explored to determine whether effects were stronger in certain subsamples. METHODS Adolescents (N = 1,450, Mage=12.7 years, 50% female), and their parents (82% mothers), were recruited from five schools to complete online surveys. Structural equation modeling was used to investigate interrelated pain-related experiences between parents and their offspring. RESULTS The adapted unified multifactorial model had good model fit in the community sample. Significant weak associations were found between all parent and child factors. The strongest associations were found in the subsample of parents and children with chronic pain. In all subgroups, internalizing factors were the most strongly linked intergenerational constructs. CONCLUSIONS Our results support the validity of the unified multifactorial model of parental factors in pediatric chronic pain, although associations were weaker in the community sample than those previously reported in a clinical sample. In children who develop chronic pain, it is important to consider their parent's chronic pain and internalizing symptoms to best manage intergenerational effects.
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Affiliation(s)
- Donnamay T Brown
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University Datteln, Germany
| | - Benedikt B Claus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University Datteln, Germany.,PedScience Research Institute, Datteln, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health-School of Medicine, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University Datteln, Germany.,PedScience Research Institute, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health-School of Medicine, Witten, Germany
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13
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Molenaar B, Willems C, Verbunt J, Goossens M. Achievement Goals, Fear of Failure and Self-Handicapping in Young Elite Athletes with and without Chronic Pain. CHILDREN-BASEL 2021; 8:children8070591. [PMID: 34356570 PMCID: PMC8305616 DOI: 10.3390/children8070591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/05/2022]
Abstract
Background: Pain is a common problem in elite athletes. This exploratory study compares goal orientations towards sport, fear of failure, self-handicapping and pain catastrophizing between active young elite athletes with and without chronic pain (CP) complaints (longer than three months). It examines the associations between chronic pain, fear of failure, goal orientations, self-handicapping and pain catastrophizing in young elite athletes. We explore how far goal orientation can be explained by these factors. Methods: Young elite athletes completed an online questionnaire. Data analysis: Independent samples t-test, correlational analyses and multivariate regression analyses. Results: Participants were 132 young elite athletes (mean 16 years); data for 126 were analyzed. A total of 47% reported current pain, of which 60% had CP. Adolescents with CP showed significantly more pain intensity, fear of failure, self-handicapping and mastery–avoidance goals than those without. Pain intensity was significantly related to fear of failure, self-handicapping, pain catastrophizing and mastery–avoidance. Self-handicapping and fear of failure contributed significantly to mastery–avoidance variance. Performance–avoidance and –approach goals were explained by fear of failure. Conclusion: CP was common, with sufferers showing more fear of failure and self-handicapping strategies, and being motivated to avoid performing worse (mastery–avoidance). Self-handicapping and fear of failure influenced mastery–avoidance orientation, and fear of failure explained part of performance–avoidance and –approach orientations. Longitudinal studies should explore the role of these factors in the trajectory of CP in these athletes.
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Affiliation(s)
- Bodile Molenaar
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
| | - Charlotte Willems
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
- Adelante Center of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
- Adelante Center of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands
| | - Mariëlle Goossens
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
- Department of Clinical Psychological Sciences, Experimental Psychology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-43-388-2160
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14
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Caes L, van Gampelaere C, Van Hoecke E, Van Winckel M, Kamoen K, Goubert L. Parental Catastrophizing and Goal Pursuit in the Context of Child Chronic Pain: A Daily Diary Study. Front Psychol 2021; 12:680546. [PMID: 34276501 PMCID: PMC8281243 DOI: 10.3389/fpsyg.2021.680546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Despite daily variability in children's chronic pain experiences, little is known about how parents' emotions and goals toward their child's pain are influenced by these daily changes. This diary study examined how daily child pain intensity (as perceived by parents) moderates the associations between parental catastrophic thoughts about child pain on the one hand, and daily parental distress and parents' goals with regard to their child's pain (pain control vs. activity engagement) on the other hand. Method: Participants were 25 parents of 20 different children (N = 18; 90% girls). Children, aged 8–14 years (M = 9.5, SD = 2.09), experienced either chronic headache or functional abdominal pain with an average pain duration of 22.5 months (SD = 24.5 months). Daily parental responses (i.e., perceived child pain intensity, distress and goal endorsement) were collected through a 3-week daily diary (resulting in 413 valid diary reports). Parents completed the Pain Catastrophizing Scale for Parents prior to starting the diary (PCS-P general) and a daily measure (PCS-P daily) included in the diary. To account for the interdependence of the data, the data were analyzed using multilevel modeling. Results: Perceived daily child pain intensity moderated the impact of parental general and daily catastrophic thoughts on parents' daily distress. Only for parents experiencing low general catastrophic thoughts an increase in distress was observed on days when they perceived their child's pain intensity as high. For all parents, high levels of perceived child pain intensity were related to more distress on days where parents reported high levels of catastrophic thinking (i.e., PCS-P daily). Perceived daily child pain intensity also moderated the impact of parental general catastrophic thinking on parents' daily endorsement of goals. Parents with high levels of general catastrophic thinking reported a lower focus on child pain control on days when child pain intensity was perceived to be low. Parents with low general catastrophic thinking reported lower endorsement of the activity engagement goal on days where the child's pain intensity was perceived to be low. Conclusion: These findings highlight the complexity of daily fluctuations in parental distress and goals regarding their child's pain. Clinical implications and future directions are critically assessed.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| | - Cynthia van Gampelaere
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Eline Van Hoecke
- Pediatric Psychology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Myriam Van Winckel
- Department of Internal Medicine and Pediatric, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | | | - Liesbet Goubert
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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15
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Ferrario I. Are remotely delivered psychological therapies effective in the management of chronic and recurrent pain in children and adolescents? A Cochrane Review summary with commentary. PM R 2021; 13:798-800. [PMID: 34032386 DOI: 10.1002/pmrj.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Irene Ferrario
- ISICO (Italian Scientific Spine Institute), Milan, Italy
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16
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Heffernan M, Wilson C, Keating K, McCarthy K. "Why Isn't It Going Away?": A Qualitative Exploration of Worry and Pain Experiences in Adolescents with Chronic Pain. PAIN MEDICINE 2021; 22:459-469. [PMID: 33001170 DOI: 10.1093/pm/pnaa245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The role of cognition is central to the fear avoidance (FA) model of chronic pain (CP), which emphasizes the importance of catastrophic pain interpretations and has been shown to be applicable to pediatric CP populations. However, while we know that pain catastrophizing plays a distinct role in influencing outcomes for children with CP, we know little about the specifics of how young people with CP experience catastrophizing and worry, as well as their general pain beliefs. OBJECTIVE To qualitatively explore beliefs about and experiences of worry and pain among a purposeful sample of adolescents with CP. METHODS Individual semistructured interviews with 12 adolescents (aged 12-17) with varying forms of CP attending an outpatient pain clinic in a general children's hospital. Relevant psychometric measures were administered orally to further inform the data. Data were analyzed using critical realist thematic analysis. RESULTS Three themes and one subtheme were identified. Themes were 1) the worry ripple: mind, body, and behavior (subtheme: worry content: personal competence and health); 2) the pain mystery: living in a "scribble of black"; and 3) the resist or avoid conundrum. CONCLUSIONS The findings highlight the need for psychological interventions targeting acceptance of uncertainty and also informing education on mind/body connections in adolescents with CP.
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Affiliation(s)
| | | | - Kim Keating
- Temple Street Children's University Hospital, Dublin, Ireland
| | - Kevin McCarthy
- Temple Street Children's University Hospital, Dublin, Ireland
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17
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Picavet HSJ, Gehring U, van Haselen A, Koppelman GH, van de Putte EM, Vader S, van der Wouden JHC, Schmits RJH, Smit HA, Wijga A. A widening gap between boys and girls in musculoskeletal complaints, while growing up from age 11 to age 20 - the PIAMA birth Cohort study. Eur J Pain 2021; 25:902-912. [PMID: 33405263 PMCID: PMC8048429 DOI: 10.1002/ejp.1719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The adolescent years represent a key period for the development of musculoskeletal complaints (MSC) and the differences between boys and girls. We evaluated the prevalence and course of MSC and factors associated with MSC while growing up from age 11 to age 20. METHODS Questionnaire-based data at age 11 (n = 2,638), age 14 (n = 2,517), age 17 (n = 2,094) and at age 20 (n = 2,206) from the ongoing Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort were analyzed. MSC refers to pain of lower back, upper- and/or lower extremities. A multivariable logistic regression analysis was used to evaluate a number of factors in relation to persistent pain (pain reported at three out of four measurements). RESULTS Prevalence of MSC increased from 14.2% at age 11 to 22.1% at age 20 for boys, and from 17.4% at age 11 to 37.9% at age 20 for girls. Persistent pain was found among 5.1% of the boys and 16.5% of the girls. Being bullied, sleeping problems and tiredness during the day were significantly associated with persistent pain, in both boys and girls, while the latter two were more prevalent among girls. Self-reported (sports-) accidents, and among girls also early onset of puberty, were also significantly associated with persistent pain, but lifestyle factors, such as physical activity and smoking, were not. CONCLUSION The prevalence of MSC increases during adolescence, with a widening gap between boys and girls. The factors associated with MSC are similar in boys and girls, though the prevalence of some of these differ by sex. SIGNIFICANCE Measuring a group of youngsters 4 times between age 11 and 20 shows an increase in the percentage reporting musculoskeletal complaints (MSC) with a widening gap between girls and boys, with more pain among girls. Boys and girls do hardly differ with respect to factors associated with MSC, being mainly psychosocial factors and (sports) accidents.
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Affiliation(s)
- H Susan J Picavet
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Amanda van Haselen
- Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, and GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Elise M van de Putte
- Division Paediatrics, Wilhelmina Children's Hospital (UMC Utrecht), Utrecht, The Netherlands
| | - Sarah Vader
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - J Hans C van der Wouden
- Department of General Practice and Elderly Care Medicine and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ruben J H Schmits
- Division Preventive Youth Health Care, Public Health Services region Utrecht (GGD Regio Utrecht), Utrecht, The Netherlands
| | - Henriette A Smit
- Division Julius Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Alet Wijga
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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18
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Ozdemir S, Gencbas D, Tosun B, Bebis H, Sinan O. Musculoskeletal Pain, Related Factors, and Posture Profiles Among Adolescents: A Cross-Sectional Study From Turkey. Pain Manag Nurs 2021; 22:522-530. [PMID: 33414011 DOI: 10.1016/j.pmn.2020.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/19/2020] [Accepted: 11/29/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of the study was to evaluate musculoskeletal pain due to mechanical reasons and related risk factors in adolescents and to define posture profiles of adolescents. DESIGN A cross-sectional study. METHODS The study was conducted with 2221 adolescents between February 2015 and May 2015. The questionnaire used to collect data consisted of three parts: (1) descriptive characteristics of the participants, (2) pain assessment of 14 parts of the body, and (3) Back Pain and Body Posture Evaluation Instrument (BackPEI). RESULTS The prevalence of low back pain among the participants was 73.3% (n = 1,343), while the prevalence of back pain was 68.4% (n = 1,254). The participants attributed their pain to their poor sitting postures at school (38.1%, n = 847) and carrying school backpacks (84.1%, n = 1,713). There was a statistically significant difference in the physical activities of adolescents and the BackPEI score (z = 4.40; p = .001). Posture factors of the BackPEI score increased while school desk comfort score increased (Spearman's rho = 0.148; p = .001), but it decreased while the school grades of the adolescents increased (Spearman's rho [ρ] = -0.161; p = .001). CONCLUSIONS According to this study, body posture was related to musculoskeletal pain and was correlated with physical activities, school desk comfort, and school grades of the adolescents. It is suggested that correct posture and ergonomic positions should be taught to adolescents when using computers, carrying school backpacks, and sitting in school chairs to prevent musculoskeletal pain.
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Affiliation(s)
- Serpil Ozdemir
- Department of Public Health Nursing, University of Health Sciences Turkey, Ankara, Turkey.
| | - Dercan Gencbas
- Department of Nursing, Atilim University, Ankara, Turkey
| | - Betul Tosun
- Department of Nursing, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Hatice Bebis
- Public Health Nursing Department, Near East University, Nicosia, Cyprus
| | - Ozlem Sinan
- Department of Public Health Nursing, Yildirim Beyazit University, Ankara, Turkey
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19
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The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients. CHILDREN-BASEL 2021; 8:children8010021. [PMID: 33406657 PMCID: PMC7824521 DOI: 10.3390/children8010021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Abstract
Youth with chronic pain and youth who have experienced stressors are at risk for poor outcomes; however, little is known about the intersection of pain and stressors. This study aims to understand the prevalence of stressors among youth with chronic pain and the relationship between stressors and pain-related outcomes. Seven hundred and seventy youth with chronic pain aged 8–18 (Mage = 14.15 years, 70% female) reported pain characteristics, stressors, anxiety, disability, and quality of life. Most participants (82%) endorsed at least one stressor. A greater number of stressors was significantly related to greater anxiety and disability, and lower levels of quality of life. School stressors were significantly associated with functional disability; family, school, and peer stressors were significantly associated with anxiety and quality of life. Stressors are common in youth with chronic pain, and the presence of stressors is related to greater functional impairment. The results of this preliminary study using semi-structured clinical interviews suggest the importance of developing a validated measure that encompasses a wide variety of stressors for youth with pain. Future research on patient-reported stressors, relative intensity, and impact are needed.
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20
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Norton J, Southon N. Exploring the Prevalence of Pediatric Chronic Pain and School Absenteeism for Therapists Working in Schools: A Systematic Review with Meta-Analysis. Phys Occup Ther Pediatr 2021; 41:227-243. [PMID: 33148083 DOI: 10.1080/01942638.2020.1836705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To explore the prevalence of school absenteeism for children with chronic pain and to identify the characteristics of children with chronic pain who report absenteeism. METHODS Systematic review with meta-analyses of quantitative studies. Studies were included if they reported mean days absent from school in children with chronic pain aged 5-18 years, attending a full-time school program. Quality of evidence was assessed using the Mixed Methods Appraisal Tool. Participant characteristics of age, gender, pain duration, pain type, and data collection setting were collated. RESULTS Eighteen quantitative studies involving 2963 children with chronic were included. Studies had moderate to high quality of evidence. Meta-analysis demonstrated 13.28 mean days were spent absent from school in a 60-day period (95% CI 10.21, 16.34) (p < 0.001). Participants were predominantly females (71.8%) aged 14.1 years (SD 2.32). The most experienced pain type was combined headache or head pain (46.9%) and average duration since pain onset was 32.5 months (SD 36.34). CONCLUSIONS Children with chronic pain aged 5-18 years are absent for approximately 22% of school days, in a 60-day period. Early, targeted intervention for absenteeism and poor school functioning is recommended. Future research could evaluate the role of school-based therapists in screening at risk students and improving attendance and outcomes.
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Affiliation(s)
- Jen Norton
- Queensland Department of Education, Mountain Creek, Queensland, Australia
| | - Nicole Southon
- Queensland Department of Education, Mountain Creek, Queensland, Australia.,The University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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21
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Jastrowski Mano KE, Beckmann EA, Fussner LM, Kashikar-Zuck S. Executive Functioning in Adolescents with Chronic Musculoskeletal Pain. CHILDREN-BASEL 2020; 7:children7120273. [PMID: 33291625 PMCID: PMC7761892 DOI: 10.3390/children7120273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
Adolescents with chronic pain often suffer significant impairment in physical, emotional, and social domains. Surprisingly little is known about executive functioning (EF) in youth with chronic pain or how EF deficits may contribute to functional impairment. Study participants included 60 adolescents between the ages of 12 and 17 years (M = 14.57). Thirty participants with chronic musculoskeletal pain and 30 age- and gender-matched healthy controls were recruited from a large Midwestern children's hospital in the United States. Participants completed the Behavior Rating Inventory of Executive Functioning (BRIEF-2) as well as multiple measures of functional impairment across key domains: school, social, emotional (anxiety, depression), and physical. Adolescents with chronic musculoskeletal pain reported significantly greater EF impairment compared to healthy age- and gender-matched peers. Clinically elevated risk levels of impairment were reported across all aspects of EF, with many adolescents in the chronic pain group scoring above the clinical risk cut off for working memory (52%), inhibition (45%), and cognitive flexibility (38%). EF was also significantly related to functional impairment across all domains. Findings suggest that EF may have an impact across several critical domains of functioning for youth with chronic pain.
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Affiliation(s)
| | - Emily A. Beckmann
- Department of Psychology, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Lauren M. Fussner
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH 45221, USA;
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22
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He T, Su J, Jiang Y, Qin S, Chi P, Lin X. Parenting Stress and Depressive Symptoms Among Chinese Parents of Children With and Without Oppositional Defiant Disorder: A Three-Wave Longitudinal Study. Child Psychiatry Hum Dev 2020; 51:855-867. [PMID: 32212023 DOI: 10.1007/s10578-020-00974-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Parents of children with oppositional defiant disorder (ODD) experience greater stress in parenting and more parental depressive symptoms. The study examined the longitudinal and bidirectional associations between three dimensions of parenting stress (i.e., parental distress, parent-child dysfunctional interaction, and difficult child) and parental depressive symptoms from a sample of Chinese parents of children with or without ODD. The sample included 256 parents of children with ODD and 265 parents of children without ODD, along with children's teachers. Using a three wave, cross-lagged design, results showed that parents of children with ODD suffered higher levels of parenting stress across three dimensions. For both groups, the links between parental depressive symptoms and subsequent parental distress and difficult child were unidirectional, whereas the relation between parental depressive symptoms and parent-child dysfunctional interaction was bidirectional. Multi-group analysis found that there was no significant difference in the relations between parenting stress and depressive symptoms between the ODD and non-ODD groups. The findings indicated that children with ODD require comprehensive services to address the stress of their parents. The study also provided support for the dynamic and longitudinal relations between specific dimensions of parenting stress and depressive symptoms among parents of children with or without ODD.
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Affiliation(s)
- Ting He
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Jinni Su
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Yongqiang Jiang
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Shaozheng Qin
- State Key Laboratory of Cognitive Neuroscience, Beijing Normal University, Beijing, China
| | - Peilian Chi
- Department of Psychology, University of Macau, Taipa, Macau SAR, China
| | - Xiuyun Lin
- Institute of Developmental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, 100875, China. .,Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China.
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23
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The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model. Clin J Pain 2020; 35:989-1002. [PMID: 31513056 DOI: 10.1097/ajp.0000000000000763] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.
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24
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Clinical Reference Points for the Screen for Child Anxiety-related Disorders in 2 Investigations of Youth With Chronic Pain. Clin J Pain 2020; 35:238-246. [PMID: 30362983 DOI: 10.1097/ajp.0000000000000667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Anxiety is common in pediatric chronic pain and is related to a higher risk for poor outcomes; thus, there is a need for effective clinical screening methods to identify youth with chronic pain and co-occurring anxiety. The Screen for Child Anxiety-related Disorders (SCARED) is a validated measure that defines clinically significant anxiety using the traditional clinical cut-off, but in pain populations, may fail to screen in youth with subclinical anxiety that may also be at increased risk. Two studies aimed to devise a clinically meaningful approach to capture anxiety severity in pediatric chronic pain. MATERIALS AND METHODS Study 1 (n=959) and Study 2 (n=207) were completed at 2 separate pediatric pain clinics, where the SCARED was administered along with measures of disability, activity limitations, pain intensity, quality of life, and pain catastrophizing. Groups with different levels of anxiety were compared on clinical outcomes via multivariate analyses of variance or independent samples t tests. RESULTS A tertile solution suggested the following anxiety groupings based on the SCARED: minimal (0 to 12), subclinical (13 to 24), and clinical (≥25). Across both studies, the tertile solution was generally superior in classifying different levels of pain-related outcomes. DISCUSSION Future directions include testing the utility of this anxiety classification system to identify youth with subclinical levels of anxiety for early intervention focused on both pain and anxiety management.
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25
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Dekker C, van Haastregt JCM, Verbunt JAMCF, de Jong JR, van Meulenbroek T, Pernot HFM, van Velzen AD, Bastiaenen CHG, Goossens MEJB. Pain-related fear in adolescents with chronic musculoskeletal pain: process evaluation of an interdisciplinary graded exposure program. BMC Health Serv Res 2020; 20:213. [PMID: 32171308 PMCID: PMC7071667 DOI: 10.1186/s12913-020-5053-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol. Objectives To evaluate whether an interdisciplinary graded exposure program, for adolescents with chronic musculoskeletal pain reporting pain-related fear, was performed according to protocol, and whether it is feasible to implement the program in rehabilitation care. Methods A process evaluation where quantitative and qualitative data on participant characteristics (adolescents, parents and therapists), attendance and participants’ opinion on the program were collected, by means of registration forms, questionnaires and group interviews. To evaluate treatment fidelity, audio and video recordings of program sessions were analyzed. Results Thirty adolescents were offered the program, of which 23 started the program. Adolescents attended on average 90% of the sessions. At least one parent per adolescent participated in the program. Analysis of 20 randomly selected recordings of treatment sessions revealed that treatment fidelity was high, since 81% of essential treatment elements were offered to the adolescents. The program was considered client-centered by adolescents and family-centered by parents. Treatment teams wished to continue offering the program in their center. Conclusion The interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program. Implementation of the program in rehabilitation care is considered feasible. Trial registration Clinicaltrials.gov ID: NCT02181725 (7 February 2014).
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Affiliation(s)
- C Dekker
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Functioning and Rehabilitation, Maastricht University, Universiteitssingel 40, 6229, ET, Maastricht, the Netherlands
| | - J C M van Haastregt
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - J A M C F Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Functioning and Rehabilitation, Maastricht University, Universiteitssingel 40, 6229, ET, Maastricht, the Netherlands. .,Adelante, Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands.
| | - J R de Jong
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Functioning and Rehabilitation, Maastricht University, Universiteitssingel 40, 6229, ET, Maastricht, the Netherlands.,Adelante, Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - T van Meulenbroek
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Functioning and Rehabilitation, Maastricht University, Universiteitssingel 40, 6229, ET, Maastricht, the Netherlands.,Adelante, Center of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - H F M Pernot
- Medicine, Laurentius Hospital Roermond, Roermond, the Netherlands
| | | | - C H G Bastiaenen
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Functioning and Rehabilitation, Maastricht University, Maastricht, the Netherlands
| | - M E J B Goossens
- Department of Rehabilitation Medicine, Care and Public Health Research Institute (CAPHRI), Functioning and Rehabilitation, Maastricht University, Universiteitssingel 40, 6229, ET, Maastricht, the Netherlands.,Department of Clinical Psychological Sciences, Experimental Psychopathology, Maastricht University, Maastricht, the Netherlands
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Grasaas E, Helseth S, Fegran L, Stinson J, Småstuen M, Haraldstad K. Health-related quality of life in adolescents with persistent pain and the mediating role of self-efficacy: a cross-sectional study. Health Qual Life Outcomes 2020; 18:19. [PMID: 32000787 PMCID: PMC6993393 DOI: 10.1186/s12955-020-1273-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 01/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Persistent pain has a high prevalence among adolescents. Pain has been shown to reduce all aspects of the adolescent’s health-related quality of life (HRQOL). In adult patients with pain, self-efficacy has been shown to mediate the relationship between pain intensity, disability and depression. However, little is known about whether self-efficacy acts as a mediating variable in the relationship between persistent pain and HRQOL sub-scale scores in a school-based population of adolescents. Objectives To describe the experience of pain, HRQOL and self-efficacy, and to explore the association between pain intensity, general self-efficacy and HRQOL in adolescents with persistent pain by testing self-efficacy as a possible mediator. Methods The study participants were 78 adolescents with persistent pain, aged 16–19 years, who were recruited from five high schools in southern Norway. All participants completed an electronic survey consisting of the Lubeck Pain Questionnaire, which included a visual analogue scale (VAS) measuring pain intensity, the General Self-Efficacy Scale (GSE) and the KIDSCREEN-52 Questionnaire measuring HRQOL. Statistical analyses were conducted using the PROCESS macro for SPSS developed by Andrew Hayes. Results All participants reported pain in multiple locations, of which the head was most common (88.5%). Mean (SD) pain intensity score of the participants was 5.4 (1.8). The study sample had poor HRQOL, with mean (SD) scores for several sub-scales ranging from 45.2 (21.0) to 91.0 (13.3) on a 0–100 scale. The associations between pain intensity and the HRQOL sub-scales of physical well-being, psychological well-being, mood, self-perception, autonomy and school environment were mediated by self-efficacy. The highest degree of mediation and, thus, the largest indirect effect was estimated for the HRQOL sub-scale physical well-being (67.2%). Conclusions This school-based sample of adolescents with persistent pain had impaired HRQOL. Up to 67% of the reduction in the HRQOL sub-scale scores for physical well-being, psychological well-being, mood, self-perception, autonomy and school environment could be explained by the mediating variable self-efficacy. Thus, future pain-management interventions that aim to increase HRQOL in school-based populations of adolescents with persistent pain should consider promoting self-efficacy and providing more targeted interventions. Trial registration ClinicalTrials.gov ID NCT03551977.
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Affiliation(s)
- Erik Grasaas
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Postbox 422, 4604, Kristiansand, Norway.
| | - Sølvi Helseth
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Postbox 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Postbox 422, 4604, Kristiansand, Norway
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Milada Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Haraldstad
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Postbox 422, 4604, Kristiansand, Norway
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Wager J, Brown D, Kupitz A, Rosenthal N, Zernikow B. Prevalence and associated psychosocial and health factors of chronic pain in adolescents: Differences by sex and age. Eur J Pain 2020; 24:761-772. [DOI: 10.1002/ejp.1526] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/19/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Donnamay Brown
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Anna Kupitz
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Nicola Rosenthal
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
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28
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Van Meulenbroek T, Huijnen I, Stappers N, Engelbert R, Verbunt J. Generalized joint hypermobility and perceived harmfulness in healthy adolescents; impact on muscle strength, motor performance and physical activity level. Physiother Theory Pract 2020; 37:1438-1447. [PMID: 31908174 DOI: 10.1080/09593985.2019.1709231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: The first aim of this study was to determine whether adolescents with asymptomatic Generalized Joint Hypermobility (GJH) have a lower level of physical functioning (physical activity level, muscle strength and performance) compared to non-hypermobile controls. Secondly, to evaluate whether the negative impact of perceived harmfulness on physical functioning was more pronounced in adolescents with asymptomatic GJH.Methods: Cross-sectional study. Sixty-two healthy adolescents (mean age 16.8, range 12-21) participated. Hypermobility (Beighton score), perceived harmfulness (PHODA-youth) and muscle strength (dynamometry), motor performance (Single-Leg-Hop-for-Distance) and physical activity level (PAL) (accelerometry) were measured. Hierarchical regression analyses were used to study differences in physical functioning and perceived harmfulness between asymptomatic GJH and non-hypermobile controls.Results: Asymptomatic GJH was associated with increased knee extensor muscle strength (peak torque/body weight; PT/BW), controlled for age and gender (dominant leg; ß = 0.29; p = .02). No other associations between asymptomatic GJH and muscle strength, motor performance and PAL were found. Perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH.Conclusions: Adolescents with asymptomatic GJH had increased knee extensor muscle strength compared to non-hypermobile controls. No other differences in the level of physical functioning was found and the negative impact of perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH.
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Affiliation(s)
- Thijs Van Meulenbroek
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Ivan Huijnen
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Nicole Stappers
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Raoul Engelbert
- ACHIEVE, Center for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
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Psychological Factors that Influence Decision-Making Regarding Trauma-Related Pain in Adolescents with Temporomandibular Disorder. Sci Rep 2019; 9:18728. [PMID: 31822745 PMCID: PMC6904577 DOI: 10.1038/s41598-019-55274-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/26/2019] [Indexed: 12/19/2022] Open
Abstract
We evaluated the clinical, magnetic resonance imaging (MRI), and psychological characteristics of adolescents with temporomandibular disorder (TMD) and compared facial macrotrauma effects between young and older adolescents. This case–control study included 70 randomly selected patients (35 young adolescents aged 12–16 years and 35 older adolescents aged 17–19 years) who had been diagnosed with TMD. Each age group was further subdivided according to the presence (T1) or absence (T0) of a macrotrauma history. All patients completed questionnaires on temporomandibular joint (TMJ) pain and dysfunction. We analyzed TMD severity symptoms using TMD-related indexes and the physical changes of TMJ using TMJ MR images. The Symptom Checklist-90-Revised was used to evaluate the patients’ psychological status. Anterior disc displacement was the most frequently observed MRI finding, occurring in a significant proportion of young (47 joints, 67.1%) and older adolescents (40 joints, 57.1%). The prevalence of all the MRI findings (disc displacement, disc deformity, condylar degeneration, and effusion) did not differ between the T0 and T1 subgroups among young and older adolescents. Conversely, the psychological factors differed significantly between the subgroups. Among young adolescents, the mean scores of somatization, obsessive-compulsiveness, hostility, phobic ideation, and psychosis were significantly higher in the T1 subgroup than in the T0 subgroup (all p < 0.05). Furthermore, these increased psychological scores positively correlated with TMD indexes. Clinicians should consider that a weakened psychological status could be an aggravating factor in young adolescents with TMD and should consider the implications in future assessment of such patients.
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30
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Friedrichsdorf SJ, Postier AC. Recent advances in pain treatment for children with serious illness. Pain Manag 2019; 9:583-596. [PMID: 31735116 DOI: 10.2217/pmt-2019-0029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pain is a common distressing symptom in children receiving pediatric palliative care. Both in children with cancer, but especially in children with progressive neurodegenerative and chromosomal conditions with CNS impairment pain is common, and often under-recognized and undertreated. Multimodal analgesia for children with serious illness acts synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality. Successful pain treatment and prevention usually include integrative 'nonpharmacological' therapies, rehabilitation, psychology and spirituality in addition to pharmacology and regional anesthesia. This review article will address these effective components of multimodal pediatric analgesia and present starting doses of basic analgesia, opioids and adjuvants analgesia in infants, children and adolescents with serious illness.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care & Integrative Medicine, Benioff Children's Hospitals at University of California - San Francisco (UCSF), CA 94158, USA.,Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Minnesota, Minneapolis, MN 55404, USA
| | - Andrea C Postier
- Department of Pain Medicine, Palliative Care & Integrative Medicine, Children's Minnesota, Minneapolis, MN 55404, USA
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31
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Evans S, Moloney C, Seidman LC, Zeltzer LK, Tsao JCI. Parental Bonding in Adolescents With and Without Chronic Pain. J Pediatr Psychol 2019; 43:276-284. [PMID: 29048481 DOI: 10.1093/jpepsy/jsx110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Parental responses influence children's pain; however, the specific role of parental bonding in pediatric pain has not been examined. Depressive symptomology is frequently reported in children with chronic pain (CP) and may play a role in the relationship between parental bonding and pain. This study examined the connections between maternal/paternal bonding (perceived care and control) and symptoms of pain and depression in adolescents with CP and in healthy adolescents. Method Participants included 116 adolescents (aged 12-17) with CP (n = 55) and without (n = 61). Adolescents completed the Parental Bonding Instrument separately for their mother and father, as well as measures of depression and pain. Results Significant associations between parental bonding and adolescent pain and depression emerged in the pain group, but not in the healthy group. There were no differences in the impact of maternal versus paternal bonding on adolescent pain and depression. Mediation analyses revealed adolescent depression was a mediator of the relationship between maternal care and adolescent pain, and paternal control and adolescent pain in the group with CP. Conclusions This study highlights the importance of considering parental bonding and adolescent depression in pediatric CP, suggesting that high paternal control and low maternal care contribute to increased pain in adolescents through heightened adolescent depressive symptoms. The findings emphasize the need for family-based treatment for CP that addresses parent behaviors and adolescent mental health.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Laura C Seidman
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Lonnie K Zeltzer
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennie C I Tsao
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
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32
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Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain. Clin J Pain 2019; 35:625-632. [DOI: 10.1097/ajp.0000000000000720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Grasaas E, Fegran L, Helseth S, Stinson J, Martinez S, Lalloo C, Haraldstad K. iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway. JMIR Res Protoc 2019; 8:e12940. [PMID: 31162132 PMCID: PMC6682291 DOI: 10.2196/12940] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Persistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management. OBJECTIVE The objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app's usability using a phased approach. METHODS Phase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app's usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data. RESULTS End users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used. CONCLUSIONS This study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample.
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Affiliation(s)
- Erik Grasaas
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Santiago Martinez
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kristin Haraldstad
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Houwing ME, de Pagter PJ, van Beers EJ, Biemond BJ, Rettenbacher E, Rijneveld AW, Schols EM, Philipsen JNJ, Tamminga RYJ, van Draat KF, Nur E, Cnossen MH. Sickle cell disease: Clinical presentation and management of a global health challenge. Blood Rev 2019; 37:100580. [PMID: 31128863 DOI: 10.1016/j.blre.2019.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 01/12/2023]
Abstract
Sickle cell disease is an autosomal recessive, multisystem disorder, characterised by chronic haemolytic anaemia, painful episodes of vaso-occlusion, progressive organ failure and a reduced life expectancy. Sickle cell disease is the most common monogenetic disease, with millions affected worldwide. In well-resourced countries, comprehensive care programs have increased life expectancy of sickle cell disease patients, with almost all infants surviving into adulthood. Therapeutic options for sickle cell disease patients are however, still scarce. Predictors of sickle cell disease severity and a better understanding of pathophysiology and (epi)genetic modifiers are warranted and could lead to more precise management and treatment. This review provides an extensive summary of the pathophysiology and management of sickle cell disease and encompasses the characteristics, complications and current and future treatment options of the disease.
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Affiliation(s)
- M E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E J van Beers
- Department of Internal Medicine and Dermatology, Van Creveldkliniek, University Medical Center Utrecht, Internal mail no C.01.412, 3508, GA, Utrecht, the Netherlands.
| | - B J Biemond
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - E Rettenbacher
- Department of Paediatric Haematology, Radboud University Medical Center - Amalia Children's Hospital, Geert Grooteplein Zuid 10, 6500, HB, Nijmegen, the Netherlands.
| | - A W Rijneveld
- Department of Haematology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - E M Schols
- Department of Haematology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands.
| | - J N J Philipsen
- Department of Cell Biology, Erasmus University Medical Center, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
| | - R Y J Tamminga
- Department of Paediatric Oncology and Haematology, University Medical Center Groningen - Beatrix Children's Hospital, Postbus 30001, 9700, RB, Groningen, the Netherlands..
| | - K Fijn van Draat
- Department of Paediatric Haematology, Amsterdam University Medical Centers - Emma Children's Hospital, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Plasma Proteins, Sanquin Research, the Netherlands.
| | - E Nur
- Department of Internal Medicine and Clinical Haematology, Amsterdam University Medical Centers, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015, CN, Rotterdam, the Netherlands.
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Fisher E, Law E, Dudeney J, Eccleston C, Palermo TM. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2019; 4:CD011118. [PMID: 30939227 PMCID: PMC6445568 DOI: 10.1002/14651858.cd011118.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND This is the first update of a review published in 2015, Issue 1. Chronic pain is common during childhood and adolescence and is associated with negative outcomes, such as increased severity of pain, reduced function, and low mood. Psychological therapies, traditionally delivered face-to-face with a therapist, are efficacious at reducing pain intensity and disability. To address barriers to treatment access, such as distance and cost of treatment, technology is being used to deliver these psychological therapies remotely. Therapies delivered remotely, such as via the Internet, computer-based programmes, and smartphone applications, can be used to deliver treatment to children and adolescents with chronic pain. OBJECTIVES To determine the efficacy of psychological therapies delivered remotely compared to waiting list, treatment as usual, or active control treatments, for the management of chronic pain in children and adolescents. SEARCH METHODS We searched four databases (CENTRAL, MEDLINE, Embase, and PsycINFO) from inception to May 2018 for randomised controlled trials (RCTs) of remotely-delivered psychological interventions for children and adolescents with chronic pain. We searched for chronic pain conditions including, but not exclusive to, headache, recurrent abdominal pain, musculoskeletal pain, and neuropathic pain. We also searched online trial registries, reference sections, and citations of included studies for potential trials. SELECTION CRITERIA We included RCTs that investigated the efficacy of a psychological therapy delivered remotely via technology in comparison to an active, treatment as usual, or waiting-list control. We considered blended treatments, which used a combination of technology and up to 30% face-to-face interaction. Interventions had to be delivered primarily via technology to be included, and we excluded interventions delivered via telephone. We included studies that delivered interventions to children and adolescents (up to 18 years of age) with a chronic pain condition or where chronic pain was a primary symptom of their condition (e.g. juvenile arthritis). We included studies that reported 10 or more participants in each comparator arm, at each extraction point. DATA COLLECTION AND ANALYSIS We combined all psychological therapies in the analyses. We split pain conditions into headache and mixed (non-headache) pain and analysed them separately. We extracted pain severity/intensity, disability, depression, anxiety, and adverse events as primary outcomes, and satisfaction with treatment as a secondary outcome. We considered outcomes at two time points: first immediately following the end of treatment (known as 'post-treatment'), and second, any follow-up time point post-treatment between three and 12 months (known as 'follow-up'). We assessed risk of bias and all outcomes for quality using the GRADE assessment. MAIN RESULTS We found 10 studies with 697 participants (an additional 4 studies with 326 participants since the previous review) that delivered treatment remotely; four studies investigated children with headache conditions, one study was with children with juvenile idiopathic arthritis, one included children with sickle cell disease, one included children with irritable bowel syndrome, and three studies included children with different chronic pain conditions (i.e. headache, recurrent abdominal pain, musculoskeletal pain). The average age of children receiving treatment was 13.17 years.We judged selection, detection, and reporting biases to be mostly low risk. However, we judged performance and attrition biases to be mostly unclear. Out of the 16 planned analyses, we were able to conduct 13 meta-analyses. We downgraded outcomes for imprecision, indirectness of evidence, inconsistency of results, or because the analysis only included one study.Headache conditionsFor headache pain conditions, we found headache severity was reduced post-treatment (risk ratio (RR) 2.02, 95% confidence interval (CI) 1.35 to 3.01); P < 0.001, number needed to treat to benefit (NNTB) = 5.36, 7 studies, 379 participants; very low-quality evidence). No effect was found at follow-up (very low-quality evidence). There were no effects of psychological therapies delivered remotely for disability post-treatment (standardised mean difference (SMD) -0.16, 95% CI -0.46 to 0.13; P = 0.28, 5 studies, 440 participants) or follow-up (both very low-quality evidence). Similarly, no effect was found for the outcomes of depression (SMD -0.04, 95% CI -0.15 to 0.23, P = 0.69, 4 studies, 422 participants) or anxiety (SMD -0.08, 95% CI -0.28 to 0.12; P = 0.45, 3 studies, 380 participants) at post-treatment, or follow-up (both very low-quality evidence).Mixed chronic pain conditionsWe did not find any beneficial effects of psychological therapies for reducing pain intensity post-treatment for mixed chronic pain conditions (SMD -0.90, 95% CI -1.95 to 0.16; P = 0.10, 5 studies, 501 participants) or at follow-up. There were no beneficial effects of psychological therapies delivered remotely for disability post-treatment (SMD -0.28, 95% CI -0.74 to 0.18; P = 0.24, 3 studies, 363 participants) and a lack of data at follow-up meant no analysis could be run. We found no beneficial effects for the outcomes of depression (SMD 0.04, 95% CI -0.18 to 0.26; P = 0.73, 2 studies, 317 participants) and anxiety (SMD 0.53, 95% CI -0.63 to 1.68; P = 0.37, 2 studies, 370 participants) post-treatment, however, we are cautious of our findings as we could only include two studies in the analyses. We could not conduct analyses at follow-up. We judged the evidence for all outcomes to be very low quality.All conditionsAcross all chronic pain conditions, six studies reported minor adverse events which were not attributed to the psychological therapies. Satisfaction with treatment is described qualitatively and was overall positive. However, we judged both these outcomes as very low quality. AUTHORS' CONCLUSIONS There are currently a small number of trials investigating psychological therapies delivered remotely, primarily via the Internet. We are cautious in our interpretations of analyses. We found one beneficial effect of therapies to reduce headache severity post-treatment. For the remaining outcomes there was either no beneficial effect at post-treatment or follow-up, or lack of evidence to determine an effect. Overall, participant satisfaction with treatment was positive. We judged the quality of the evidence to be very low, meaning we are very uncertain about the estimate. Further studies are needed to increase our confidence in this potentially promising field.
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Affiliation(s)
- Emma Fisher
- Pain Research Unit, Churchill HospitalCochrane Pain, Palliative and Supportive Care GroupOxfordUK
| | - Emily Law
- University of WashingtonAnesthesiology and Pain MedicineSeattleWashingtonUSA
| | - Joanne Dudeney
- Seattle Children's Research InstituteCenter for Child Health, Behavior, and Development2001 8th Avenue, Suite 400SeattleWashingtonUSA
| | | | - Tonya M Palermo
- University of WashingtonAnesthesiology and Pain MedicineSeattleWashingtonUSA
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Necessary Adaptations to CBT with Pediatric Patients. HANDBOOK OF COGNITIVE BEHAVIORAL THERAPY FOR PEDIATRIC MEDICAL CONDITIONS 2019. [DOI: 10.1007/978-3-030-21683-2_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Gauntlett-Gilbert J, Alamire B, Duggan GB. Pain Acceptance in Adolescents: Development of a Short Form of the CPAQ-A. J Pediatr Psychol 2018; 44:453-462. [PMID: 30496433 DOI: 10.1093/jpepsy/jsy090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals Bath, Royal National Hospital for Rheumatic Diseases
- Faculty for Health and Applied Sciences, University of the West of England
| | - Batool Alamire
- Bath Centre for Pain Services, Royal United Hospitals Bath, Royal National Hospital for Rheumatic Diseases
| | - Geoffrey B Duggan
- Bath Centre for Pain Services, Royal United Hospitals Bath, Royal National Hospital for Rheumatic Diseases
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Pain in Mucopolysaccharidoses: Analysis of the Problem and Possible Treatments. Int J Mol Sci 2018; 19:ijms19103063. [PMID: 30297617 PMCID: PMC6213542 DOI: 10.3390/ijms19103063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/30/2018] [Accepted: 10/02/2018] [Indexed: 01/01/2023] Open
Abstract
Mucopolysaccharidosis (MPS) are a group of lysosomal storage disorders that are caused by the deficiency of enzymes involving in the catabolism of glycosaminoglycan (GAGs). GAGs incompletely degraded accumulate in many sites, damaging tissues and cells, leading to a variety of clinical manifestations. Many of these manifestations are painful, but few data are available in the literature concerning the prevalence, etiology, and pathogenesis of pain in children with MPS. This review, through the analysis of the data available the in literature, underscores the relevant prevalence of pain in MPSs’ children, provides the instruments to discern the etiopathogenesis of the disease and of pain, illustrates the available molecules for the management of pain and the possible advantages of non-pharmacological pain therapy in MPSs’ patients.
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Khu M, Soltani S, Neville A, Schulte F, Noel M. Posttraumatic stress and resilience in parents of youth with chronic pain. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1514606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Melanie Khu
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Sabine Soltani
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Alexandra Neville
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated With Hip Preservation Surgery. J Pediatr Orthop 2018; 38:254-259. [PMID: 27328119 DOI: 10.1097/bpo.0000000000000816] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adolescent hip preservation surgery (HPS) candidates typically present with chronic pain, which can negatively affect psychological function and surgical outcomes. A previous study demonstrated high rates of psychological symptoms and maladaptive behaviors in this population. This study quantified psychological and functional improvements in these patients from preoperative presentation to postoperative follow-up. An integrated interdisciplinary approach is also described. METHODS A total of 67 patients undergoing HPS were evaluated preoperatively and postoperatively at 1 year by staff psychologists. Perioperative psychological intervention consisted of education, counseling, and administration of self-report measures. Self-report measure scores were compared preoperatively and postoperatively, grouped by orthopaedic diagnoses. Frequency analysis, correlational analysis, and analysis of variance were conducted. RESULTS Psychological function improved significantly at follow-up: decreased emotional symptomatology (46.1 to 43.6, P=0.013), anxiety (49.6 to 45.8, P<0.001), school problems (46.6 to 44.7, P=0.035), internalizing problems (46.3 to 44.1, P=0.015), social stress (44.5 to 42.3, P=0.024), sense of inadequacy (49.0 to 46.0, P=0.004), and increased self-concept (51.1 to 54.1, P=0.003). Resiliency factors also significantly improved: increased mastery (50.3 to 52.9, P=0.001) and resourcefulness (49.7 to 52.0, P=0.046), decreased emotional reactivity (46.3 to 42.9, P=0.001), and vulnerability (47.7 to 44.7, P=0.011). Physical function and return to activity also significantly improved (University of California-Los Angeles: 7.1 to 8.7, P=0.017; modified Harris Hip Score: 67.3 to 83.8, P<0.001). Return to activity positively correlated with optimism and self-efficacy (P=0.041). Femoroacetabular impingement and hip dysplasia patients consistently reported feeling less depressed (P=0.036), having fewer somatic complaints (P=0.023), fewer internalized problems (P=0.037), and exhibiting fewer atypical behaviors (P=0.036) at follow-up. Slipped capital femoral epiphysis patients did not demonstrate improvements in psychological functioning postoperatively. CONCLUSIONS Perioperative psychological education and counseling, in combination with HPS, improved postoperative psychological and physical function. Patients reported reduced anxiety, school problems, and social stress, with marked increase in resilience. Increased mobility and return to activity significantly correlated with improved optimism and self-efficacy. LEVEL OF EVIDENCE Level II-therapeutic studies-investigating the results of treatment.
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41
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Wurm M, Anniko M, Tillfors M, Flink I, Boersma K. Musculoskeletal pain in early adolescence: A longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender. J Psychosom Res 2018; 111:76-82. [PMID: 29935758 DOI: 10.1016/j.jpsychores.2018.05.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Adolescence is a time of change during which several health problems, such as pain problems, increase. Psychosocial mechanisms involved in this development, such as interpersonal stressors and worry, are still understudied, especially longitudinally. The first aim of this study was to investigate the prevalence of musculoskeletal pain in Swedish adolescents between the ages 13 and 15 using pain grades. The second aim was to study the role of peer-related stress, worry, and gender in the development of musculoskeletal pain problems over time. METHODS Adolescents in 18 public schools were followed from 7th to 9th grade (N = 1181) and answered self-report questionnaires at three time points. Prevalence was assessed at all three time points and a moderated mediation analysis investigated if peer-related stress in 7th grade predicted musculoskeletal pain two years later and if this relationship was mediated by worry in 8th grade. Gender was entered as a moderator. RESULTS In 7th grade, 8.4% of adolescents reported musculoskeletal pain with some functional impairment. In 8th and 9th grade around 10% of adolescents reported musculoskeletal pain problems, with girls reporting a higher prevalence than boys. Peer-related stress in 7th grade predicted musculoskeletal pain problems in 9th grade, mediated by worry in 8th grade. The mediation was moderated by gender: peer-related stress predicted worry for girls, but not for boys. CONCLUSION Peer-related stress and worry seem to be involved in the development of pain over time. These factors should therefore be targeted in preventative interventions and during treatment.
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Affiliation(s)
- Matilda Wurm
- Centre of Health and Medical Psychology (CHAMP), Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
| | - Malin Anniko
- Centre of Health and Medical Psychology (CHAMP), Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Maria Tillfors
- Department of Social and Psychological Studies, Psychology, Karlstad University, Karlstad, Sweden
| | - Ida Flink
- Centre of Health and Medical Psychology (CHAMP), Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Katja Boersma
- Centre of Health and Medical Psychology (CHAMP), Department of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Correlation between the pain numeric rating scale and the 12-item WHO Disability Assessment Schedule 2.0 in patients with musculoskeletal pain. Int J Rehabil Res 2018; 41:87-91. [DOI: 10.1097/mrr.0000000000000262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Getting Back to Living: Further Evidence for the Efficacy of an Interdisciplinary Pediatric Pain Treatment Program. Clin J Pain 2018; 33:535-542. [PMID: 27584815 DOI: 10.1097/ajp.0000000000000433] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined key functional outcomes following a 3-week interdisciplinary pediatric pain rehabilitation program for adolescents with chronic pain. Maintenance of gains was evaluated at 3-month follow-up. METHODS Participants included 171 adolescents (12 to 18 y of age) with chronic pain who completed a hospital-based outpatient pediatric pain rehabilitation program. Participants completed measures of functional disability, depressive symptoms, pain catastrophizing, opioid use, school attendance, and pain severity at admission, discharge, and at 3-month follow-up. RESULTS Similar to other interdisciplinary pediatric pain rehabilitation program outcome studies, significant improvements were observed at the end of the program. These improvements appeared to be maintained or further improved at 3-month follow-up. Nearly 14% of the patients were taking daily opioid medication at admission to the program. All adolescents were completely tapered off of these medications at the end of the 3-week program and remained abstinent at 3-month follow-up. DISCUSSION This study adds to the available data supporting interdisciplinary pediatric pain rehabilitation as effective in improving functioning and psychological distress even when discontinuing opioids. Implications for future research and limitations of the study are discussed.
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Fisher E, Bromberg MH, Tai G, Palermo TM. Adolescent and Parent Treatment Goals in an Internet-Delivered Chronic Pain Self-Management Program: Does Agreement of Treatment Goals Matter? J Pediatr Psychol 2018; 42:657-666. [PMID: 28008004 DOI: 10.1093/jpepsy/jsw098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/15/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To assess whether adolescent-parent agreement on treatment goals as part of an Internet-delivered cognitive-behavioral pain intervention was associated with adolescent outcomes. 122 adolescent-parent dyads selected two treatment goals. Pain intensity and pain-related disability were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-ups. We compared dyads who had goal agreement versus no agreement. 74 dyads (61%) agreed on one or more treatment goals, most commonly going to school, sports, and sleep. In dyads who chose the same goal, regardless of the content, adolescents had lower pain intensity post-treatment and at follow-up. When goals were categorized by domain, in dyads who agreed on physically active goals, adolescents were more likely to report lower pain intensity compared with other groups. Agreement of goals was not associated with changes in pain-related disability. Agreement on treatment goals may be an important treatment process to maximize outcomes in self-management therapies.
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Affiliation(s)
- Emma Fisher
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Maggie H Bromberg
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Gabrielle Tai
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute
| | - Tonya M Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute.,Department of Anesthesiology and Pain Medicine, University of Washington
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A Conceptual Framework for Understanding the Role of Adverse Childhood Experiences in Pediatric Chronic Pain. Clin J Pain 2017; 33:264-270. [PMID: 27275737 DOI: 10.1097/ajp.0000000000000397] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This review outlines a conceptual framework adapted from the biopsychosocial model of pain to examine the relationship between adverse childhood experiences (ACEs) and chronic pain in youth to highlight the state of current research and guide future efforts. METHODS A review of the literature was performed in the areas of ACEs and health outcomes with general adult and pediatric populations in addition to studies within the pain literature. Potential relationships between ACEs, chronic pain, and its impact in youth are outlined and discussed. RESULTS The literature suggests an association between adverse outcomes of ACEs and chronic pain in children and adolescents although causal links have not been confirmed. However, ACEs are associated with multiple risk factors identified in the biopsychosocial model of pain, and may serve to exacerbate or confer heightened risk for pain and poor outcomes. DISCUSSION Adverse experiences in childhood may be associated with greater risk for the development/maintenance of chronic pain in youth. More research is needed on ACEs and how they uniquely affect the biopsychosocial mechanisms underlying chronic pain in children throughout the lifespan.
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46
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School Anxiety in Children and Adolescents with Chronic Pain. Pain Res Manag 2017; 2017:8328174. [PMID: 29081682 PMCID: PMC5634599 DOI: 10.1155/2017/8328174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
Anxiety is highly prevalent in pediatric chronic pain. This comorbidity has been explained by the presence of shared mechanisms underlying the development and maintenance of chronic pain and anxiety. Accumulating evidence demonstrates that school is a significant source of anxiety among youth with chronic pain and that anxiety contributes to school-related functional impairment in this population. This article reviews the cooccurrence of pediatric chronic pain and anxiety, identifies unique sources of heightened school anxiety among youth with chronic pain, and describes current approaches for assessing anxiety in pediatric pain settings. Highlighted by this review is the absence of a comprehensive evidence-based approach for assessing school anxiety in pediatric chronic pain. Given the psychometric limitations inherent to gathering data from a single source, recommendations for advancing measurement methods are provided. Novel approaches may be needed to shed more light on the way in which school anxiety is experienced in pediatric chronic pain.
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Lee RR, Rashid A, Ghio D, Thomson W, Cordingley L. Chronic Pain Assessments in Children and Adolescents: A Systematic Literature Review of the Selection, Administration, Interpretation, and Reporting of Unidimensional Pain Intensity Scales. Pain Res Manag 2017; 2017:7603758. [PMID: 28912638 PMCID: PMC5585620 DOI: 10.1155/2017/7603758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/12/2017] [Accepted: 07/10/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Advances in pain assessment approaches now indicate which measures should be used to capture chronic pain experiences in children and adolescents. However, there is little guidance on how these tools should best be administered and reported, such as which time frames to use or how pain scores are categorised as mild, moderate, or severe. OBJECTIVE To synthesise current evidence on unidimensional, single-item pain intensity scale selection, administration, interpretation, and reporting. METHODS Databases were searched (inception: 18 January 2016) for studies in which unidimensional pain intensity assessments were used with children and adolescents with chronic pain. Ten quality criteria were developed by modifying existing recommendations to evaluate the quality of administration of pain scales most commonly used with children. RESULTS Forty-six studies met the inclusion criteria. The highest score achieved was 7 out of a possible 10 (median: 5; IQR: 4-6). Usage of scales varied markedly in administrator/completer, highest anchors, number of successive assessments, and time referent periods used. CONCLUSIONS Findings suggest these scales are selected, administered, and interpreted inconsistently, even in studies of the same type. Furthermore, methods of administration are rarely reported or justified making it impossible to compare findings across studies. This article concludes by recommending criteria for the future reporting of paediatric chronic pain assessments in studies.
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Affiliation(s)
- Rebecca Rachael Lee
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - Amir Rashid
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - Daniela Ghio
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - Wendy Thomson
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
| | - Lis Cordingley
- NIHR Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
- Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PT, UK
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LEE PERLHAN, YEH YICHUN, HSIAO RAYC, YEN CHENGFANG, HU HUEIFAN. Pain-related quality of life related to mental health and sociodemographic indicators in adolescents. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- PERL HAN LEE
- Kaohsiung Medical University Hospital, Taiwan; Kaohsiung Medical University, Taiwan
| | - YI-CHUN YEH
- Kaohsiung Medical University Hospital, Taiwan; Kaohsiung Medical University, Taiwan
| | - RAY C. HSIAO
- University of Washington, United States; Children’s Hospital, United States
| | - CHENG-FANG YEN
- Kaohsiung Medical University Hospital, Taiwan; Kaohsiung Medical University, Taiwan
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Sørensen K, Christiansen B. Adolescents' experience of complex persistent pain. Scand J Pain 2017; 15:106-112. [PMID: 28850332 DOI: 10.1016/j.sjpain.2017.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/09/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Persistent (chronic) pain is a common phenomenon in adolescents. When young people are referred to a pain clinic, they usually have amplified pain signals, with pain syndromes of unconfirmed ethology, such as fibromyalgia and complex regional pain syndrome (CRPS). Pain is complex and seems to be related to a combination of illness, injury, psychological distress, and environmental factors. These young people are found to have higher levels of distress, anxiety, sleep disturbance, and lower mood than their peers and may be in danger of entering adulthood with mental and physical problems. In order to understand the complexity of persistent pain in adolescents, there seems to be a need for further qualitative research into their lived experiences. The aim of this study was to explore adolescents' experiences of complex persistent pain and its impact on everyday life. METHODS The study has an exploratory design with individual in-depth interviews with six youths aged 12-19, recruited from a pain clinic at a main referral hospital in Norway. A narrative approach allowed the informants to give voice to their experiences concerning complex persistent pain. A hermeneutic analysis was used, where the research question was the basis for a reflective interpretation. RESULTS Three main themes were identified: (1) a life with pain and unpleasant bodily expressions; (2) an altered emotional wellbeing; and (3) the struggle to keep up with everyday life. The pain was experienced as extremely strong, emerging from a minor injury or without any obvious causation, and not always being recognised by healthcare providers. The pain intensity increased as the suffering got worse, and the sensation was hard to describe with words. Parts of their body could change in appearance, and some described having pain-attacks or fainting. The feeling of anxiety was strongly connected to the pain. Despair and uncertainty contributed to physical disability, major sleep problems, school absence, and withdrawal from leisure activities. Their parents were supportive, but sometimes more emotionally affected than themselves. The adolescents described how they strived for normality and to not become an outsider. Being met with necessary facilitation from school was important, as well as keeping up with friends. These adolescents had all been treated by an interdisciplinary pain team, and stated that they had an optimistic view of the future, despite still having some symptoms. CONCLUSIONS The study provides new insights into adolescents' own experiences of complex persistent pain occurring unexpectedly, developing dramatically over time, and influencing all parts of their everyday lives. The adolescents entered vicious cycles, with despair and decreased physical and social functioning, with the risk of isolation and role-loss. However, these young people seem to have a strong motivation to strive for normalcy. IMPLICATIONS These findings may encourage healthcare providers to perceive adolescents' persistent pain through the lenses of a biopsychosocial approach. We suggest that further research into adolescents with persistent pain should include longitudinal studies of quality of life and gender perspectives.
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Affiliation(s)
- Kari Sørensen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Lovisenberg Diaconal University College, Olso, Norway
| | - Bjørg Christiansen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postbox 4, St. Olavs pl., N-0130Oslo, Norway
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Friedrichsdorf SJ, Giordano J, Desai Dakoji K, Warmuth A, Daughtry C, Schulz CA. Chronic Pain in Children and Adolescents: Diagnosis and Treatment of Primary Pain Disorders in Head, Abdomen, Muscles and Joints. CHILDREN (BASEL, SWITZERLAND) 2016; 3:E42. [PMID: 27973405 PMCID: PMC5184817 DOI: 10.3390/children3040042] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/26/2016] [Accepted: 12/01/2016] [Indexed: 12/12/2022]
Abstract
Primary pain disorders (formerly "functional pain syndromes") are common, under-diagnosed and under-treated in children and teenagers. This manuscript reviews key aspects which support understanding the development of pediatric chronic pain, points to the current pediatric chronic pain terminology, addresses effective treatment strategies, and discusses the evidence-based use of pharmacology. Common symptoms of an underlying pain vulnerability present in the three most common chronic pain disorders in pediatrics: primary headaches, centrally mediated abdominal pain syndromes, and/or chronic/recurrent musculoskeletal and joint pain. A significant number of children with repeated acute nociceptive pain episodes develop chronic pain in addition to or as a result of their underlying medical condition "chronic-on-acute pain." We provide description of the structure and process of our interdisciplinary, rehabilitative pain clinic in Minneapolis, Minnesota, USA with accompanying data in the treatment of chronic pain symptoms that persist beyond the expected time of healing. An interdisciplinary approach combining (1) rehabilitation; (2) integrative medicine/active mind-body techniques; (3) psychology; and (4) normalizing daily school attendance, sports, social life and sleep will be presented. As a result of restored function, pain improves and commonly resolves. Opioids are not indicated for primary pain disorders, and other medications, with few exceptions, are usually not first-line therapy.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA.
| | - James Giordano
- Georgetown University Medical Center, Washington, DC 20057, USA.
| | | | - Andrew Warmuth
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Cyndee Daughtry
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Craig A Schulz
- Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
- Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN 55455, USA.
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